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Royal Super 4th Year Brain > ENT/Optho > Flashcards

ENT/Optho Flashcards

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1
Q

Ciliary flush - what is it and what does it represent?

A

= circum-corneal hyperemia with conjunctival redness concentrated in area adjacent to cornea
- Significant corneal pathology (e.g., keratitis, anterior uveitis, acute angle-closure glaucoma)

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2
Q

First-line for bacterial conjunctivitis in contact lens wearer

A

Ciprofloxacin

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3
Q

What complication of bacterial conjunctivitis do you worry about for a contact lens wearer?

A

Keratitis - inflammation of cornea

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4
Q

What do you think of with FB sensation of eye with signs of conjunctivitis?

A

Adenovirus keratoconjunctivitis

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5
Q

What are you looking for in HSV keratitis on slit lamp exam?

A

Dendritic pattern

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6
Q

When does rebleeding typically occur for traumatic hyphema?

A

Within one week

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7
Q

What complicated bug do you think of for a contact wearer with conjunctivitis? What would you treat with?

A

Pseudomonas - fluoroquinolones (erythromycin)

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8
Q

Genetic syndromes associated with nasolacrimal duct obstruction (x3)

A

CHARGE, T21, and Goldenhar

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9
Q

When should retinal hemorrhages secondary to birth trauma to resolve?

A

By two weeks of life

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10
Q

What virus to think of with bilateral swelling to periauricular area and progressing to jaw

A

Adeno

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11
Q

Complications of AOM

A

Meningitis, abscesses, sigmoid sinus thrombosis, focal encephalitis, otitic hydrocephalus, CN palsy

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12
Q

Gradenigo syndrome

A

CN 6 palsy

-Suppurative AOM, anterior displacement of ear

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13
Q

Abx choice for mild to moderate sinusitis

A

Amoxicillin high dose

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14
Q

What is happening and what do you do for a child with tympanostomy tube insertion with otorrhea and ear pain?

A

Tympanostomy tube otorrhea

  • reassurance if <7 days
  • cipro and dex drops
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15
Q

Tx for mastoiditis

A

IV vanco and myringotomy tubes

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16
Q

Complications of sinusitis intracranially

A

CVST, epidural abscess, subdural empyema, meningitis

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17
Q

Other CNS-related causes for Vocal cord paralysis

A

Chiari, hydrocephalus, myelomeningiocele, birth trauma

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18
Q

Ddx for leukocoria

A
  • Cataract
  • Retinoblastoma
  • Retinal coloboma
  • ROP
  • Persistent hyperplastic primary vitreous
  • Coat’s disease
  • Toxocariasis
  • Retinal detachment/dysplasia
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19
Q

Location of (a) thyroglossal duct cyst and (b) brachial cleft cyst?

A

(a) midline

(b) anterior to SCM

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20
Q

x2 most common bacteria for otitis externa

A

Staph aureus + pseudomonas

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21
Q

What do you worry about for an orbital wall fracture?

A

-Trapdoor fracture = of inferior rectus muscle

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22
Q

What is the job of CN-7 vs CN-3 for the upper eyelid?

A
  • CN-7 = like a hook that pulls the eyelid closed

- CN-3 = like roman columns to keep eyelid open

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23
Q

What do you see on imaging for orbital cellulitis?

A
  • Sinus opacification
  • Subperiosteal abscess
  • Periorbital fat stranding
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24
Q

What to do about a subperiosteal abscess in setting of orbital cellulitis?

A

Expected finding

-Nothing to do as long as uncomplicated course

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25
Q

What is blepharitis and what is it associated with?

A

=eyelid margin inflammation

-Associated with meibomian gland dysfunction

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26
Q

DDx for ptosis

A
  • Congenital = dystrophic levator muscle
  • Mechanical = hemangioma
  • Trauma
  • Myogenic = muscular dystrophy
  • Neuromyogenic = myasthenia gravis
  • Neurogenic = CN III palsy
  • Idiopathic
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27
Q

Clues on exam for congenital/infantile dystrophy of levator palpebrae superioris muscle?

A
  • No eyelid crease

- Infant using frontalis muscle to open eyelid

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28
Q

What is the difference between (a) CN III palsy and (b) Horner syndrome related ptosis?

A

(a) BIG ptosis

b) Small ptosis, small pupil (anisocoria), interruption of sympathetic innervation (lighter pigmentation

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29
Q

Difference between hordeolum vs chalazion?

A 
Hord = acute inflam
Chal = chronic inflam
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30
Q

Presentation of dacryocystocele

A

=distal blockage = appears as purple/blue dot

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31
Q

Presentations for (a) conjunctivitis (x3 types), (b) keratitis, and (c) iritis-acute/chronic?

A

(a) Bacterial (purulent), viral (watery-mucoid), allergic (watery + pruritic), inflammatory (minimal discharge)
(b) pain, white spot on cornea, vision loss
(c) acute (ciliary flush with severe pain), chronic (no redness or pain in JIA)

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32
Q

What to worry about if pupil appears tear drop?

A

Ruptured globe

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33
Q

What is microhyphema + what happens to the pupil?

A
  • Accumulation of blood in the anterior chamber of the eye
  • Common after blunt injuries
  • Pupil is shocked = slightly oval
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34
Q

What does WBCs within the anterior chamber of the eyeball bilaterally worry you about?

A

JIA associated uveitis

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35
Q

In terms of normal visual development, what should a (a) 6-8 week old, (b) 2-3 month old, and (c) 3-4 month old be able to do?

A

(a) eye contact + react to facial expressions
(b) interest in bright objects
(c) eyes aligned, fix+follow

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36
Q

At what age can amblyopia not develop after?

A

9-10 years old

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37
Q

What is amblyopia?

A

Abnormal visual development leading to decreased visual acuity

38
Q

What x3 big causes of amblyopia (+ example of each)?

A
  • Need for correction = refractive error
  • Media opacity = cataract
  • Malignment = strabismus
39
Q

How can you treat strabismus?

A
  • Occlusion = patching

- Pharmacologic = eye drops in good eye

40
Q

Best test to detect strabismus?

A

Cover/uncover test

41
Q

How long does it take for 90% of AOM with effusion to be completely cleared?

A

3 months

42
Q

Extra-cranial complications of AOM

A
  • TM perforation
  • Mastoiditis
  • Labyrinthitis
  • Labrinthine fistula
  • CN VII palsy
  • Bezold’s abscess
  • Periauricular abscess
  • Cholesteatoma
43
Q

What should you always use for a draining ear?

A

Ciprodex drops

44
Q

Intracranial complications of AOM

A
  • Meningitis
  • Brain abscess
  • Sino-venous thrombosis
  • Gradenigo’s syndrome
  • Otic hydrocephalus
  • CSF leak
45
Q

When to refer for tympanostomy tubes?

A
  • Recurrent AOM with effusion
  • Complications of AOM (mastoiditis)
  • Bilateral effusion lasting >3 months with CHL
  • Unilateral or bilateral OME lasting >3 months with other problems (discomfort, behavioural problems)
  • At risk children
  • Chronic retraction of TM
  • Lack of response to medical therapy
46
Q

What is the most common congenital birth defect?

A

SNHL

47
Q

What is the most common cause of non-genetic hearing loss?

A

Congenital CMV

48
Q

Risk factors for hearing loss (x5)

A

ABCD’s:

  • Affected family member
  • Bilirubin
  • Congenital intra-uterine infection
  • Defects of the ENT
  • Small BW (<1500g), low APGAR, NICU
49
Q

Absolute + relative indications for adenotonsillectomy

A

Absolute:

  • OSA with AHI >5/hr + large tonsils
  • Cor pulmonale
  • Suspected malignancy
  • Hemorrhagic tonsillitis
  • Severe dysphagia

Relative:

  • Tonsillar hypertrophy
  • Recurrent tonsillitis
  • Complications of tonsillitis
  • Tonsilloliths + halitosis
50
Q

Management of sinonasal infections

A
  • Abx
  • Nasal CC’s
  • Decongestants
  • Surgical intervention
51
Q

In setting of nasal trauma + possible fracture, what do you want to ensure if not present on exam?

A

Septal hematoma

52
Q

Most frequent area of bleeding for epistaxis?

A

-Little’s area or Kiesselbach’s plexus

53
Q

What threshold do you look at for pre-vertebral soft tissue for RPA?

A

> 7mm at C2

>14mm at C6/C7

54
Q

Where is the location of the defect if there is (a) inspiratory, (b) biphasic, and (c) expiratory?

A

(a) supraglottis
(b) vocal cords, subglottis
(c) trachea, bronchi

55
Q

What are the causes of biphasic stridor?

A

=location vocal cords/subglottis

  • Bilateral vocal cord paresis
  • Subglottic stenosis
  • Glottic web
  • Subglottic hemangioma
  • Subglottic cyst
  • Laryngeal cleft
  • FB
  • Papillomatosis
  • Croup
56
Q

What are the causes of expiratory stridor?

A

=think trachea/bronchi

  • Tracheomalacia
  • FB
  • TEF
  • Complete tracheal rings
57
Q

When to think of a subglottic hemangioma?

A
  • When croup presents too early

- If there is a beard distribution of hemangiomas

58
Q

When does laryngomalacia (a) present, (b) worsen, (c) plateau, and (d) resolve?

A

(a) First days of life
(b) 6 months of life
(c) 6-12 months of life
(d) 18-24 months of life

59
Q

What can do as pre-op mitigation strategies for button battery?

A

-Home = honey
-Hopsital = sucralafate
10mL q10 minutes

60
Q

Dx of a non-tender, growing lesion overlying parotid gland?

A

Mycobacterial avium adenitis

61
Q

Tx for Mycobacterial avium adenitis

A

Clarithromycin x7-10 days

  • I+D if medical tx not effective
  • Excision if not improved
62
Q

What hearing screen should you consider if (a) no risk factors and (b) risk factors present?

A

(a) OAE - otoacoustic emissions

(b) ABR = auditory brainstem response

63
Q

Midline congenital neck masses

A
  • thyroglossal duct cyst
  • dermoid cyst
  • teratoma
  • cervical cleft
  • ranula
  • vascular malformation
64
Q

Lateral congenital neck masses

A
  • Branchial cleft cyst
  • Hemangioma
  • Thymic cyst
  • Vascular malformation
  • Laryngocele
65
Q

What neck mass moves with tongue protrusion?

A

Thyroglossal duct cyst

66
Q

What neck mass presents with calcifications on XR?

A

Dermoid cyst

67
Q

What neck mass is smooth along SCM border?

A

-Branchial cleft cyst

68
Q

What neck mass enlarges with valsalva?

A

Laryngocele

69
Q

What virus to think about when bilateral conjunctivitis with bilateral preauricular LAD?

A

Adeno

70
Q

What ENT infection do you think of when there is trismus?

A

Peritonsillar abscess

71
Q

What is Gradenigo Syndrome?

A
  • Complication of suppurative OM
  • CN VI palsy
  • Facial pain
72
Q

Post-tonsillectomy halitosis secondary to superficial infection - what is the management?

A

Optimize tylenol and analgesics

73
Q

Most common cause of SNHL?

A

Genetics

74
Q

x2 most important aspects of management for mastoiditis

A

IV Abx + myringotomy tubes

75
Q

What is a bezold abscess?

A

Complication of mastoiditis - infection that extends into the neck musculature

76
Q

x4 day-time symptoms of untreated OSA

A
  • Growth failure
  • Fatigue, headaches
  • Attention/behavioural
  • Cardiovascular (pHTN)
77
Q

Intracranial complications of sinusitis

A 
Epidural abscess
Subdural abscess
Brain abscess
Meningitis
CVST
78
Q

5 yo girl with nasal congestion. What supports a diagnosis of acute bacterial sinusitis?

a. fever for at least 3 days
b. rhinorrhea persisting 12 days
c. frontal headache
d. nasal discharge that changes from clear to purulent

A

B

79
Q
  1. Baby with inspiratory stridor, soft voice, vocals abduct in inspiration, what is the diagnosis?
    a) Laryngomalacia
    b) Tracheomalacia
    c) Vocal cord palsy
A

A

80
Q

x3 things to worry about in setting of bilateral vocal cord paralysis

A
  • Hydrocephalus
  • Chiari malformation
  • Myelomeningocele
81
Q

Is tonsillectomy required for peritonsillar abscess?

A

No - but may be considered

82
Q

Indications for tonsillectomy for tonsillitis?

A
  • =/>7 in 1 year
  • =/>5 in 2 years
  • =/> 3 in 3 years
83
Q

What x2 sinuses are present at birth?

A

Ethmoid + maxillary

84
Q

What is the last sinus to develop

A

Frontal

85
Q

What is a concerning complication of cataract surgery?

A

Glaucoma

86
Q

Optic neuritis - resolved 3 months ago - how to counsel and what comorbidity is possible?

A
  • Likely no recurrence

- MS

87
Q

Triad of infantile glaucoma plus x3 other common sx

A
  • Blepharospasm
  • Tearing
  • Photophobia
  • Corneal enlargement, edema, conjunctival injection
88
Q

Other names for (a) anterior and (b) posterior uveitis - and what one is typically painful?

A

(a) iritis - pain+

(b) chorioretinitis

89
Q

How to treat for (a) anterior and (b) posterior uveitis?

A

(a) topical steroids

(b) systemic steroids

90
Q

When is rebleeding from a hyphema likely?

A

1 week

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